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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Surface Replacing Arthroplasty for Metacarpophalangeal Joint Arthitis; a comparison of etiologies
Heath P. Melugin, MD; Eric R. Wagner, MD; Jason Srnec, MD; Laurel Barras, MD; William Robinson, MD; Bayard C. Carlson, MD; Moran L. Steven, MD; Marco Rizzo, MD
Mayo, Rochester, MN

Purpose:There remains a paucity of studies examining surface replacing arthroplasty (SRA) in the treatment of pathologies of the MCPJ. The objective of this study was to assess the results MCP arthroplasty utilizing the SRA prosthesis for various surgical indications.

Methods:We performed an analysis of 76 primary MCP arthroplasties with the SRA prosthesis in 34 patients for osteoarthritis at our institution from 1998 to 2006. The mean age at surgery was 55 years, BMI 25, with 46% involving the dominant extremity, 80% females, 20% smokers, no laborers, and 3% with diabetes mellitus (DM). There were 61 patients with inflammatory arthritis, 10 with osteoarthritis (OA), and 5 with post-traumatic arthritis. The following are patient characteristics between the inflammatory arthritis, OA and post-traumatic groups: age (54, 61, 58), females (88%, 60%, 20%), and DM (3%, 0%, 0%).

Results:There were 15 revision surgeries performed at a mean 3.1 years postoperatively, including 13 in patients with inflammatory arthritis and 2 in those with osteoarthritis. The 2, 5 and 10-year survival rates were 90%, 84%, and 74%, respectively. The 5-year survival rates for the inflammatory arthritis, OA, and post-traumatic arthritis were 84%, 73%, and 100% (p=0.32), respectively. Postoperative complications include 3 dislocations, but no infections, cases of heterotopic ossification or postoperative fractures. 33 (43%) of patients had recurrent ulnar deviation as determined by the surgeon clinically. There were no significant differences in the rate of dislocations between the surgical indications, but patients with inflammatory arthritis had higher rates of ulnar deviation (p<0.01). In those unrevised patients, at a mean 7.0 years (2-12) follow-up, preoperative to postoperative pain levels significantly improved (p<0.01). MCP total arc of motion slightly improved from 38opreoperatively to 51opostoperatively (p=0.22), while there was no significant change in grip or pinch strength (p>0.19). Total arc of motion was slightly decreased in the post-traumatic group (45o), compared to the OA (50o) and inflammatory arthritis (60o) groups (p=0.66).

Summary Points:MCP arthroplasty utilizing the SRA prosthesis is associated with reasonable medium term survival and low complications, but have high rate of recurrent ulnar deviation.Patients experience predictable pain relief and slight improvements in their motion.SRA implants has the potential to be considered as an alternative prosthesis, especially in patients with post-traumatic or osteoarthritis.


Figure 1. Kaplan Meier survival analysis of inflammatory arthritis (red), osteoarthritis (green) and post-traumatic arthritis (blue).


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